Apparatus for rotating medical devices, systems including the apparatus, and associated methods

ABSTRACT

A rooter includes a rotatable element, an actuator for causing the rotatable element to rotate, and a coupling feature for rotatably coupling an elongate medical instrument to the rotatable element. The rotatable element may be at least partially contained within the interior of a housing or another element that remains substantially stationary as the actuator causes the rotatable element to rotate. The rooter may be used with a variety of elongate medical instruments, such as needles, drill bits, trocars, wires, catheters, tubes, and other elongate instruments that are used to enable or effect medical procedures within the body of a subject. The rooter may be used for a variety of purposes, including, without limitation, the introduction of an elongate medical instrument into the body of a subject or its removal from the subject&#39;s body; removing, breaking up, or eliminating obstructions (e.g., blood clots, plaques, etc.) from the body of a subject; and obtaining samples from a subject&#39;s body.

TECHNICAL FIELD

The present invention relates generally to apparatuses and methods forrotating, or spinning, medical devices and, more specifically, toapparatuses and methods for manually spinning medical devices. Inparticular, the present invention includes apparatuses and methods forspinning needles, catheters, wires, trocars, and other elongate medicalinstruments that may be used to enable or effect a medical procedurewithin the body of a subject.

SUMMARY

In one aspect, the present invention includes various embodiments of anapparatus for causing an elongate medical instrument to rotate, or spin,about its longitudinal axis. Such an apparatus may be referred to hereinas a “rooter.” In a specific embodiment, such an apparatus includes ahousing, a rotatable element within the housing, retention elements forsecuring the rotatable element in place relative to the housing, and anactuator that causes the rotatable element to rotate within the housing.

The rotatable element may be configured to engage an elongate medicalinstrument, such as a catheter, a needle, a wire, a trocar, or anotherelongate element that may be used to enable or effect a medicalprocedure within the body of a subject. In various embodiments, at leastone end of the rotatable element, which is accessible from an end of thehousing, may be configured to receive and retain the elongate medicalinstrument. In some embodiments, the rotatable element may comprise anelongate member with a longitudinal axis, about which the rotatableelement may rotate, or spin. In a more specific embodiment, therotatable element may include a helical ridge, similar to the thread ofa bolt or screw.

The rotatable element may be disposed within an interior of the housingin a manner that enables the rotatable element to spin about itslongitudinal axis. As the rotatable element rotates within the housing,which may remain substantially stationary (e.g., within a user's grasp,etc.), a medical element engaged by the rotatable element may rotate.

An actuator may be associated with the rotatable element in such a wayas to cause the rotatable element to rotate. In a specific embodiment,the actuator may include an external element configured for manualoperation, as well as an internal element that interacts with therotatable element. In embodiments where the rotatable element has ahelical ridge, the internal element of the actuator may be positionedbetween longitudinally adjacent locations of the helical ridge. In suchembodiments, the actuator may move longitudinally relative to therotatable element (e.g., in directions substantially parallel to therotational axis of the rotatable element, etc.), while the internalelement of the actuator and the helical ridge of the rotatable elementinteract with one another to cause the rotatable element, as well as anymedical element engaged thereby, to rotate, or spin.

Longitudinal movement of the actuator may be enabled by an elongate slotthat extends through the housing, along at least a portion of itslength. The elongate slot may receive an intermediate element of theactuator, holding the actuator in place as it is moved along the lengthof the rotatable element.

The present invention also includes systems for effecting medicalprocesses. A system of the present invention includes a rooter, as wellas an elongate medical instrument, such as a catheter, a wire, a needle,a drill bit, a trocar, or another elongate element that may be used toenable or effect a medical procedure within the body of a subject,associated with the rooter. The rooter may be manually operable. As therooter operates, it causes the elongate medical instrument to rotate orspin.

In another aspect, the present invention includes methods for rotatingor spinning elongate medical instruments. In such a method, an elongatemedical instrument is associated with (e.g., engaged by, etc.) arotatable element of a rooter. Manual operation of an actuator of therooter (e.g., as a user holds the rooter with one hand and moves theactuator with the user's thumb or finger, etc.) causes the rotatableelement, along with the elongate medical instrument that has beensecured to the rotatable element, to rotate or spin. The rotatingelongate medical instrument may be used to effect a variety of medicalprocedures, depending at least in part upon the type of elongate medicalinstrument that has been assembled with the rooter.

Other aspects, as well as features and advantages of various aspects, ofthe present invention will become apparent to those of skill in the artfrom consideration of the ensuing description, the accompanyingdrawings, and the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings:

FIG. 1 is a perspective view of an embodiment of rooter of the presentinvention;

FIG. 2 is an exploded view of the embodiment of rooter shown by FIG. 1;

FIGS. 3A, 3B, and 3C are, respectively, bottom, distal end, and proximalend views of a housing of the embodiment of rooter depicted by FIGS. 1and 2;

FIGS. 4A, 4B, and 4 c are, respectively, side, distal end, and proximalend views of a rotatable element of the embodiment of rooter shown inFIGS. 1 and 2;

FIGS. 5A, 5B, and 5C are side, rear, and front views, respectively, of acap of the embodiment of rooter illustrated by FIGS. 1 and 2;

FIGS. 6A, 6B, and 6C are, respectively, side, distal end, and proximalend views of a proximal retention element of the embodiment of rootershown in FIGS. 1 and 2;

FIG. 6D is a cross-section taken through the length of the proximalretention element depicted by FIGS. 6A-6C;

FIGS. 7A, 7B, and 7C are, respectively, side, distal end, and proximalend views of a distal retention element of the embodiment of rooterillustrated by FIGS. 1 and 2;

FIGS. 8A and 8B are side and front views, respectively, of an actuatorof the embodiment of rooter shown in FIGS. 1 and 2;

FIG. 8C is a cross-section through the length of the actuator shown inFIGS. 8A and 8B;

FIGS. 9A-9C are perspective, proximal end, and section views,respectively, of another embodiment of rooter of the present invention;

FIG. 10 illustrates an embodiment of rooter with a pair of connectedhandles;

FIG. 11 depicts an embodiment of gear-driven rooter;

FIGS. 12A-12C shown an embodiment of rooter that rotates under controlof a rack and pinion mechanism; and

FIG. 13 shows a manner in which an elongate medical instrument may beassembled with a rooter of the present invention.

DETAILED DESCRIPTION

With reference to FIGS. 1 and 2, an embodiment of rooter 10 thatincorporates teachings of the present invention is illustrated. Rooter10 includes a housing 20, a rotatable element 40, a distal retentionelement 60 and a proximal retention element 70, and an actuator 90.

The housing 20, which is also shown in FIGS. 3A-3C, is an elongateelement with an exterior 22 and a hollow interior 24. In the depictedembodiment, the housing 20 is cylindrical in shape, with a longitudinalaxis 21 extending centrally through the length of the housing 20. Thehousing 20 includes a distal end 26 and an opposite, proximal end 30. Alongitudinal slot 34 extends along a portion of the length of thehousing 20.

The distal end 26, which is the end of the housing 20 that may belocated farthest from an individual during use of the rooter 10 (FIGS. 1and 2), is partially closed, as depicted by FIG. 3B. In a specificembodiment, the distal end 26 may include a circumferential lip 27 thatdefines an opening 28, which extends through the housing 20, from itsexterior 22 to its interior 24. The opening 28 may be centered about thelongitudinal axis 21 of the housing 20.

As seen in FIG. 3C, the proximal end 30 of the housing 20, which may belocated closest to the individual during operation of the rooter 10, mayinclude an opening 32 that exposes the interior 24 of the housing 20. Insome embodiments, the proximal end 30 of the housing 20 may beconfigured to receive a cap 56 (FIGS. 5A-5C), which may at leastpartially close the opening 32 at the proximal end 30.

The longitudinal slot 34, illustrated in FIGS. 3A and 3C, extendsthrough a wall of the housing 20, from the exterior 22 of the housing 20to the interior 24 of the housing 20. In the embodiment depicted by FIG.3A, the longitudinal slot 34 is substantially linear. A distal end 36 ofthe longitudinal slot 34 may be located adjacent to, but proximallyspaced apart from, the distal end 26 of the housing 20. An opposite,proximal end 38 of the longitudinal slot 34 is located at or near (i.e.,distally spaced apart from) the proximal end 30 of the housing 20.

The rotatable element 40 of the embodiment of rooter 10 (FIGS. 1 and 2)illustrated by FIGS. 4A-4C is an elongate element that is configured tobe assembled with the housing 20 (FIGS. 3A-3C) of the rooter 10. In someembodiments, the rotatable element 40 may be tubular and, thus, includea conduit 55 extending through its length. A longitudinal axis 41 of therotatable element 40 extends centrally or substantially centrallythrough a length of the rotatable element 40. In embodiments where therotatable element 40 includes a conduit 55, the conduit 55 and thelongitudinal axis 41 of the rotatable element 40 may be aligned (e.g.,concentric, etc.).

In the depicted embodiment, the rotatable element 40 includes anintermediate portion 45, as well as a distal portion 42 and a proximalportion 50 at opposite ends of the intermediate portion 45.

The intermediate portion 45, which may be generally cylindrical inshape, includes a rotation facilitator 47. In the illustratedembodiment, the rotation facilitator 47 comprises a helical ridge, whichprotrudes from an outer surface 46 of the intermediate portion 45. Inparticular, the helical ridge 47 may wrap circumferentially around theintermediate portion 45. The helical ridge 47 extends along at least aportion of the length of the intermediate portion 45. In someembodiments, the helical ridge 47 may extend along only a part of theintermediate portion 45, as in the depicted embodiment, where the endsof the helical ridge 47 are spaced apart from corresponding ends of theintermediate portion 45.

The distal portion 42 of the rotatable element 40 may also becylindrical in shape. In the embodiment shown in FIGS. 4A-4C, the distalportion 42 of the rotatable element 40 has a smaller diameter than theintermediate portion 45 of the rotatable element 40. Thus, acircumferential ledge 44 is present at the boundary between the distalportion 42 and the intermediate portion 45. The distal portion 42 mayalso be configured to pass through the opening 28 in the distal end 26of the housing 20 (FIGS. 3A and 3C), and to protrude from the distal end26. The distal portion 42 may be configured to engage or be engaged bythe distal retention element 60 (FIGS. 7A-7C). In this regard, a distalportion 42 of some embodiments of a rotatable element 40 of a rooter 10of the present invention may include one or more retention features 43,such as the helical thread shown in FIG. 4A.

The proximal portion 50 of the rotatable element 40 may likewise have acylindrical shape. In some embodiments, the proximal portion 50 may beconfigured to protrude beyond the proximal end 30 of the housing 20 of arooter 10 of the present invention. The proximal portion 50 may beconfigured to engage or be engaged by the proximal retention element 70(FIGS. 6A-6D). Such engagement may, in some embodiments, be at leastpartially enabled by at least one retention feature 52, such as thehelical thread illustrated by FIG. 4A.

A circumferential rim 54, which extends around and protrudes from theouter surface 46 of the rotatable element 40, may delimit, or define aboundary between, the intermediate portion 45 of the rotatable element40 and its proximal portion 50. The circumferential rim 54 may provide astop for an actuator 90 (FIGS. 8A-8C) that cooperates with the rotatableelement 40 and is configured to cause the rotatable element 40 to rotateabout its longitudinal axis 41.

In some embodiments, a rooter 10 (FIGS. 1 and 2) of the presentinvention may include a cap 56 configured to cooperate with thecircumferential rim 54 to retain the rotatable element 40 within theinterior of the housing 20. An embodiment of cap 56 that may be used aspart of the rooter 10 (FIGS. 1 and 2) is shown in FIGS. 5A-5C. The cap56 may be configured to be disposed over the opening 32 (FIGS. 3A and3C) in the proximal end 30 of the housing 20. In a specific embodiment,the cap 56 may include a receptacle 57 that receives the proximal end 30of the housing 20. An interior surface of an end 58 of the cap 56 may beconfigured to abut the circumferential rim 54 (FIGS. 4A and 4C) of therotatable element 40 and an edge of the proximal end 30 of the housing20, while an aperture 59 through the end 58 of the cap 56 may beconfigured to receive the proximal portion 50 of the rotatable element40.

In some embodiments, a fixed handle 110 may protrude from the cap 56. Aconfiguration of the fixed handle 110 may enable a user to at leastpartially grasp the rooter 10 (FIGS. 1 and 2) or hold it in place with athumb or palm of a single hand.

The cap 56 may, in some embodiments, be held in place on the proximalend 30 of the housing 20 by way of the proximal retention element 70, anembodiment of which is depicted in FIGS. 6A-6D. The proximal retentionelement 70 is configured to be coupled with the proximal portion 50(FIGS. 4A and 4C) of the rotatable element 40. More specifically, theproximal retention element 70 may have the appearance of a cap, with anopen distal end 72 and a receptacle 74 that are configured to receivethe proximal portion 50 of the rotatable element 40. In addition, at anopposite end of the receptacle 74 from the open distal end 72, theproximal retention element 70 may have a substantially closed proximalend 78.

The receptacle 74 may be configured to engage or to be engaged by theproximal portion 50 (FIGS. 4A and 4C) of the rotatable element 40. In aspecific embodiment, the receptacle 74 may include at least oneretention feature (not shown), such as a helical thread on an interiorsurface 75 of the receptacle 74, configured to mutually engage acorresponding retention feature 52 of the proximal portion 50 of therotatable element 40.

An opening 79 may extend through the proximal end 78 of the proximalretention element 70. In some embodiments, such as that illustrated byFIGS. 6A-6D, the proximal retention element 70 and, in a particularembodiment, its opening 79 may be configured to receive and engage anelongate medical instrument, such as a wire (e.g., a guide wire, a wireused for other purposes, etc.), a catheter, or another elongate elementthat may be used to enable or effect a medical procedure within the bodyof a subject. In the illustrated embodiment, the opening 79 through theproximal end 78 of the proximal retention element 70 communicates with aconduit 82 of a male member 80. The male member 80 extends through thereceptacle 74 of the proximal retention element 70. When used with anembodiment of rotatable element 40 (FIGS. 4A-4C) that includes a conduit55, the male member 80 of the proximal retention element 70 may beconfigured for insertion into the conduit 55.

In some embodiments, the proximal retention element 70 may be configuredto engage an elongate medical instrument 200 (FIG. 13) in a manner thatcauses the elongate medical instrument 200 to rotate as the proximalretention element 70 rotates. For example, and not to limit the scope ofthe present invention, the surfaces that define the opening 79 throughthe proximal end 78 of the proximal retention element 70 may beconfigured to lock onto, grasp, or engage a surface 208 of the elongatemedical instrument 200. As another non-limiting example, the proximalretention element 70 may include one or more features (e.g., a retentionslot, a locking feature, etc.) that communicate or are otherwiseassociated with the opening 79 through the proximal end 78 to enableselective locking, grasping, or other engagement of the surface 208 ofthe elongate medical instrument 200. In yet another non-limitingexample, the proximal retention element 70 may be configured to couplewith a separate device (not shown) that locks onto, grasps, or otherwiseengages the surface 208 of the elongate medical instrument 200.

The distal retention element 60, an embodiment of which is illustratedby FIGS. 7A-7C, may also have the general appearance of a cap, with anopen proximal end 62, an interior receptacle 64 that communicates withproximal end 62, and a substantially closed distal end 68. The proximalend 62 and the receptacle 64 are configured to receive the distalportion 42 (FIGS. 4A and 4B) of the rotatable element 40. In someembodiments, the receptacle 64 includes one or more retention features(not shown), which may be configured to mutually engage a correspondingretention feature 43 of the distal portion 42 of the rotatable element40, such as a helical thread carried by the surface 65 of the depictedreceptacle 64.

The distal end 68 of the distal retention element 60 may include anopening 69, which may be configured to receive an elongate medicalinstrument 200 (FIG. 13), such as a catheter, wire (e.g., a guide wire,a wire used for other purposes, etc.), a needle, a trocar, or anotherelongate element that may be used to enable or effect a medicalprocedure within the body of a subject. When such a distal retentionelement 60 is configured for assembly with an embodiment of rotatableelement 40 (FIGS. 4A-4C) that includes a conduit 55 extendingtherethrough, the opening 69 through the distal end 68 of the distalretention element 60 may be configured for alignment and/orcommunication with the conduit 55.

In addition to being configured to receive an elongate medicalinstrument 200 (FIG. 13), some embodiments of distal retention elements60 may be configured to lock onto, grasp, or otherwise engage, or atleast partially engage, the elongate medical instrument 200. Withoutlimiting the scope of the present invention, a distal retention element60 may include a locking element (not shown) at its distal end 68,external or internal (i.e., within the opening 69 in the distal end 68)threading, internal features (e.g., ribs, etc.) that lock onto, grasp,or otherwise engage an outer surface 208 of the elongate medicalinstrument 20Q, other locking features, or the distal retention element60 may be configured to couple with a separate device (not shown) thatlocks onto, grasps, or otherwise engages the surface 208 of the elongatemedical instrument 200.

Turning now to FIGS. 8A-8C, an embodiment of an actuator 90 that may beused with the embodiments of housing 20 and rotatable element 40 shownin FIGS. 4A-4C is illustrated. In particular, the actuator 90 may beconfigured to interact with the rotatable element 40 in a manner thatcauses the rotatable element 40, when assembled with the housing 20, torotate about its longitudinal axis 41. In various embodiments, theactuator 90 includes one or more drive features 96 for causing therotatable element 40 to rotate.

In the depicted embodiment, the actuator 90 comprises a cylindricalelement 92 with an aperture 94 extending through its length. Theaperture 94 is configured to receive the rotatable element 40 (FIGS.4A-4C) and, more specifically, to receive the intermediate portion 45 ofthe rotatable element 40, enabling the cylindrical element 92 of theactuator 90 to move along the length of the rotatable element 40. Theinterior surface 95 of the cylindrical element 92—i.e., the surface ofthe aperture 94—may define one or more drive features 96. In thespecific embodiment shown in FIGS. 8B and 8C, the drive features 96 maybe configured to engage a corresponding rotation facilitator 47 of theintermediate portion 45 of the rotatable element 40. More specifically,the drive features 96 may engage the rotation facilitator 47, which maycomprise a helical ridge, of the intermediate portion 45 of therotatable element 40.

In addition to including an element configured to cause the rotatableelement 40 to rotate, an actuator 90 of a rooter 10 of the presentinvention may include an intermediate element 98, which may beconfigured to reside within and move back and forth through thelongitudinal slot 34 in the housing 20.

On an opposite side of the intermediate element 98, the actuator 90 mayinclude a manual trigger 100, which may be engaged by a portion of auser's hand, such as a finger or thumb.

In some embodiments, such as that depicted by FIG. 1, a rooter 10 thatincorporates teachings may also include a return element 101, such as aspring, that causes the actuator 90 and its manual trigger 100 to returnto or substantially to an initial position. When the manual trigger 100is moved in a first direction (e.g., proximally, etc.), energy may bestored in the return element 101. When the manual trigger 100 isreleased, the resilience of the return element 101, and the energystored within the return element 101, may cause the actuator 90,including the manual trigger 100, to move in an opposite, seconddirection (e.g., distally, etc.) along the lengths of the housing 20 andthe rotatable element 40 of the rooter 10. As illustrated by FIG. 1, thereturn element 101 may comprise an internal compression spring, which,in the depicted embodiment, is compressed between an edge of thecylindrical element 92 of the actuator 90 and an interior surface of theend 58 of the cap 56 as the manual trigger 100 and, thus, thecylindrical element 92 are drawn proximally along the rotatable element40 and the housing 20. Of course, other embodiments of return elements101, including other types of internal springs, external springs, andother apparatus that will cause the actuator 90 to automatically reverseits position.

In some embodiments, the automatic return of the actuator 90 to itsinitial position may also cause the rotatable element 40 to rotate inits opposite direction.

In other embodiments, including embodiments where movement of therotatable element 40 in a single direction (e.g., clockwise orcounterclockwise) is desired or oscillatory movement of the rotatableelement 40 is not desired, the actuator 90 of a rooter 10 of the presentinvention may be configured to return to its initial position withoutcausing further rotation of the rotatable element 40. Without limitingthe scope of the present invention, an actuator 90 may disengage therotation facilitator 47 of the rotatable element 40 as the actuator 90returns to its initial position, or the actuator 90 may otherwise beconfigured to return to its initial position without disengaging therotation facilitator (e.g., the actuator 90 may include a ratchetmechanism that allows it to return to its initial position withoutdisengaging the rotation facilitator 47, etc.).

Returning reference to FIG. 2, assembly of a rooter 10 that includes theabove-described elements may be accomplished by assembling the rotatableelement 40 and the actuator 90. The distal portion 42 of the rotatableelement 40 may be introduced into and through the aperture 94 of thecylindrical element 92 of the actuator 90. As the rotatable element 40is pushed distally through the aperture 94, the drive features 96 of theactuator may engage the rotation facilitator 47 that protrudes from theouter surface 46 of the intermediate portion 45 of the rotatable element40.

Assembly of the housing 20 and the actuator 90 may include introductionof the cylindrical element 92 of the actuator into the opening 32 at theproximal end 30 of the housing 20, with the intermediate element 98 ofthe actuator 90 located within the longitudinal slot 34 through thehousing 20. The manual trigger 100 is, of course, located outside of thehousing 20, and protrudes from the housing 20.

The distal portion 42 of the rotatable element 40 may be introduced intothe opening 32 at the proximal end 30 of the housing 20 to assemble therotatable element 40 with the housing 20. The distal portion 42 of therotatable element 40 is then moved distally through the interior 24 ofthe housing 20, until the distal portion 42 reaches the distal end 26 ofthe housing 20. The distal portion 42 of the rotatable element 40 maythen be introduced into and through the opening 28 in the distal end 26of the housing 20, until the distal portion 42 of the rotatable element40 protrudes from the distal end 26 of the housing 20.

With the distal portion 42 of the rotatable element 40 protruding fromthe distal end 26 of the housing 20, the longitudinal position of therotatable element 40 within the interior 24 of the housing 20 may befixed or substantially fixed by coupling the distal retention element 60to the distal portion 42 of the rotatable element 40.

When the housing 20 and the rotatable element 40 are assembled, theproximal portion 50 of the rotatable element 40 protrudes beyond theproximal end 30 of the housing 20. To hold the rotatable element 40 andthe actuator 90 within the interior 24 of the housing 20, the cap 56 maythen be placed over the proximal end 30 of the housing 20. Morespecifically, the receptacle 57 of the cap 56 may be positioned over theproximal end 30 of the housing 20. Additionally, the proximal portion 50of the rotatable element 40 may be aligned with the aperture 59 throughthe end 58 of the cap 56. As the cap 56 moves distally relative to thehousing 20 and the rotatable element 40, the proximal portion 50 of therotatable element 40 may be positioned around proximal portion 50 of therotatable element 40.

The cap 56 may be held in place relative to the proximal end 30 of thehousing 20 by coupling the proximal retention element 70 to theprotruding proximal portion 50 of the rotatable element 50.

Other embodiments of rooters that incorporate teachings of the presentinvention are shown in FIGS. 9A-11. Features of those embodiments may,unless otherwise described, operate in the same manner or in a mannersimilar to the corresponding elements of the rooter 10 that has beendescribed in reference to FIGS. 1-8C.

In FIGS. 9A-9C, an embodiment of rooter, 10′ is depicted that includes alongitudinal slot 14′ that extends the entire length of the device. Thelongitudinal slot 14′ includes portions that extend through the distalretention element 60′, the housing 20′ and rotatable element 40′, andthe proximal retention element 70′. In the depicted embodiment, thelongitudinal slot 14′ is wider at its opening 15′ (i.e., at the surfacesor circumferences of one or more of the distal retention element 60′,the housing 20′ (and, optionally, the rotatable element 40′), and theproximal retention element 70′) than at its closed edge 18′, which, insome embodiments, may be located at or extend to a location just beyonda longitudinal axis 41′ of the rotatable element 40′ of the rooter 10′.Slots 14′ that are tapered in this manner may be configured to receiveand retain (e.g., by interference fit, etc.) elongate medicalinstruments 200 (FIG. 13) of a variety of different diameters or gauges.

FIGS. 9A-9C also illustrate another embodiment of manual trigger 100′and handle 110′ that may be used with a rooter (e.g., rooter 10′, etc.)according to the present invention. The manual trigger 100′ includes aconcave surface 102′ with a proximal portion 104′ oriented generallyparallel with the housing 20′ of the rooter 10′ and a distal portion106′ extending away from the housing 20′. The configuration andorientation of the manual trigger 100′ enable it to be easily movedalong the length of the housing 20′, particularly when a user wraps hisor her fingers around the housing 20′. In order to accommodate theuser's fingers, and to enhance the user's grasp on the housing 20′, ahandle 110′ may be positioned on an opposite or substantially opposite(e.g., diametric, etc.) side of the housing 20′ from the manual trigger100′. In the depicted embodiment, the handle 110′ is an elongate elementwith a plurality of concave indentations 112′ for receiving the user'sfingers.

Referring now to FIG. 10, an embodiment of rooter 10″ that lacks ahousing, and includes a scissor-like handle 120″ is shown. Instead of ahousing, rooter 10″ includes a stationary sleeve 20″ and a translatablesleeve 25″. The stationary sleeve 20″ and the translatable sleeve 25″both include cylindrical openings.

Stationary sleeve 20″ is configured to be longitudinally retained withina retention section 51″ of a rotatable element 40″ of the rooter 10″.The retention section 51″ is defined by a pair of spaced apartcircumferential rims 54 a″ and 54 b″ protruding from the outer surface46″ of the rotatable element 40″, and a smooth, cylindrically shapedportion of the outer surface 46″ located between the circumferentialrims 54 a″ and 54 b″. Although the retention section 51″ is depicted inFIG. 10 as being located near the proximal portion 50″ of the rotatableelement 40″, rotatable elements with retention portions at otherlongitudinal locations are also within the scope of the presentinvention.

The translatable sleeve 25″ is configured to interact with a rotationfacilitator 47″ of the rotatable element 40″. In the depictedembodiment, the translatable sleeve 25″ may be configured like, orsimilar to, the cylindrical element 92 of the actuator 90 described inreference to FIGS. 8A-8C.

Retention elements 60″ and 70″ on opposite ends 48″ and 49″,respectively, of the rotatable element 40″. In the depicted embodiment,retention element 60″ may prevent movement of the translatable sleeve25″ beyond its corresponding end 48″ of the rotatable element 40″. (Ofcourse, in embodiments where the retention section 51″ of the rotatableelement 40″ is located at or nearer to a distal portion 42″ of therotatable element 40″, the proximal retention element 70″ locatedadjacent to a proximal portion 50″ of the rotatable element 40″ mayprevent the translatable sleeve 25″ from moving beyond its correspondingend 49″ of the rotatable element 40″). One or both retention elements60″ and 70″ may be configured to engage an elongate medical instrument200 (FIG. 13).

The handle 120″ includes two handle members 100″ and 110″. The handlemembers 110″ and 100″ extend from the stationary sleeve 20″ and thetranslatable sleeve 25″, respectively. In the depicted embodiment, eachhandle member 100″, 110″ is pivotally associated with its correspondingsleeve 20″, 25″. Handle members 100″ and 110″ cross at somewhatintermediate locations 105″ and 115″, respectively, and are joined toone another at those locations by a hinge 125″. As the handle members100″ and 110″ are drawn together or forced apart, the translatablesleeve 25″ interacts with the rotation facilitator 47″ of the rotatableelement 40″, causing the rotatable element 40″ to rotate.

In another embodiment, shown in FIG. 11, a rooter 10″′ of the presentinvention may include an actuator 90″′ that comprises a rotatable gear92″′. As the rotatable gear 92″′ of the actuator 90″′ rotates (e.g., byuse of a thumb to rotate the actuator 90″′ or a feature thereof, etc.),it engages another gear of a rotation facilitator 47″′ associated with(e.g., surrounding, at least partially surrounding, etc.) the rotatableelement 40″′ of rooter 10″′ ((e.g., extending circumferentially around aportion of the rotatable element 40″′, etc.). In such an embodiment, theactuator 90″′ may remain in a stationary position along the length ofthe rooter 10″′ (i.e., along the lengths of the housing 20″′ and therotatable element 40″′) as the rotatable element 40″′ rotates.

FIGS. 12A-12C depict an embodiment of rooter 10″″ in which the actuator90″″ includes a manual trigger 92″″ and a gear rack 96″″. The manualtrigger 92″″ is translatably associated with the housing 20″″ of therooter 10″″ (e.g., pivotally, such as in the depicted embodiment; like apush button, etc.). In various embodiments, the manual trigger 92″″ maybe operated with a user's thumb or finger. In some embodiments, aresilient element 93″″ (e.g., a spring, etc.) may be associated with themanual trigger 92″″ in such a way as to cause the manual trigger 92″″ toreturn to its initial position after the manual trigger 92″″ has beendepressed or otherwise actuated.

The gear rack 96″″ of the actuator 90″″ may be associated with themanual trigger 92″″ in such a way that, when the manual trigger 92″″ isdepressed or otherwise actuated, the gear rack 96″″ moves in a desireddirection. In the depicted embodiment, depression of the manual trigger92″″ causes the gear rack 96″″ to move in a first direction across, ortransverse to, the length of a rotatable element 40″″ of the rooter10″″, which is disposed within an interior of the housing 20″″. When themanual trigger 92″″ is released, the resilient element 93″″, if any, maycause the gear rack 96″″ to move in an opposite, second direction acrossthe rotatable element 40″″.

A gear 47″″ with teeth that are configured and spaced to mesh with teethof the gear rack 96″″ is positioned along the length of the rotatableelement 40″″ at a location where the gear 47″″ will cooperate with thegear rack 96″″. As the manual trigger 92″″ moves and causes the gearrack 96″″ to move, the gear rack 96″″ rotates the gear 47″″. Rotation ofthe gear 47″″, in turn, rotates the rotatable element 40″″, along withany elongate medical instrument 200 (FIG. 13) that has been directly orindirectly coupled to the rotatable element 40″″.

Turning now to FIG. 13, a rooter that incorporates teachings of thepresent invention (rooter 10 is shown, merely to provide an example) maybe used to rotate an elongate medical instrument 200. Non-limitingexamples of elongate medical instruments 200 that may be used with arooter of the present invention include catheters, wires (e.g., guidewires, etc.), needles, drill bits, trocars, and other elongate elementsthat may be used to enable or effect medical procedures within the bodyof a subject. Depending upon their intended or desired use, theseelongate medical instruments may be configured with a variety of tips ordistal elements, or with accessories such as balloons, brushes, stents,electrodes, sensors, cutting elements, optics, or wiring.

In use, a proximal end 202 of an elongate medical instrument 200 mayintroduced into an opening 69 in the distal end 68 of the distalretention element 60 of the rooter 10. When the elongate medicalinstrument 200 comprises a relatively short device, such as a needle,trocar, or the like, insertion of the proximal end 202 of the elongatemedical instrument 200 into the opening 69 may at least partially couplethe elongate medical instrument 200 to the rooter 10 without insertingthe elongate medical instrument 200 further into the rooter 10. Inembodiments where the elongate medical instrument 200 comprises a longerdevice, such as a catheter, wire or the like, its proximal end 202 maybe inserted only into the opening 69 of the distal end 68 of the distalretention element 60, or the proximal end 202 may be inserted furtherinto the rooter 10. Without limiting the scope of the present invention,the proximal end 202 of the elongate medical instrument 200 may also bepushed proximally through the conduit 55 of the rotatable element 40 ofthe rooter 10, and through the opening 79 through the proximal end 78 ofthe proximal retention element 70 of the rooter 10.

With the elongate medical instrument 200 in place, it may berotationally coupled to the rooter 10. In embodiments where the distalretention element 60 and/or the proximal retention element 70 of therooter 10 includes features that lock onto, grasp, or otherwise engage asurface 208 of the elongate medical instrument 200, rotational couplingof the elongate medical instrument 200 to the rooter 10 occurs duringassembly of the elongate medical instrument 200 with the rooter 10. Inother embodiments, at least one separate locking device 210 may beassembled with and lock onto, grasp, or otherwise engage the surface 208of the elongate medical instrument 200, then each locking device 210 maybe coupled to the distal retention element 60 or the proximal retentionelement 70 of the rooter 10. Rotational coupling of the elongate medicalinstrument 200 to the distal retention element 60 or the proximalretention element 70 may be effected in a manner that causes theelongate medical instrument 200 to rotate as the distal retentionelement 60 and/or the proximal retention element 70 rotates.

A distal end 204 of the elongate medical instrument 200 may beintroduced into a body of a subject at a desired location. In someembodiments, the distal end 204 may be inserted into the subject's bodybefore the elongate medical instrument 200 is assembled with the rooter10. In other embodiments, the rooter 10 may be assembled with anelongate medical instrument 200 that has already been introduced, or atleast partially introduced, into the subject's body.

Rotation of the elongate medical instrument 200 (e.g., about itslongitudinal axis 201, etc.) may be effected by causing the rotatableelement 40, as well as the distal retention element 60 and/or theproximal retention element 70, to rotate (e.g., about longitudinal axis41, etc.). In the illustrated embodiment, such rotation may be caused bymoving the manual trigger 100 of the rooter 10's actuator 90 along thelength of the rooter 10's housing 20. As the manual trigger 100 is movedalong the length of the housing 20, the intermediate element 98 of theactuator 90 moves through the longitudinal slot 34 in the housing 20,which causes the cylindrical element 92 of the actuator 90 within theinterior 24 of the housing to move along the length of the rotatableelement 40. As the cylindrical element 92 moves along the length of therotatable element 40, drive features 96 (FIGS. 8B and 8C) on or in theinterior surface 95 of the aperture 94 of the cylindrical element 92 mayengage the complementarily configured rotation facilitator 47 of therotatable element 40 (e.g., the depicted helical ridge, etc.). Theconfigurations of the longitudinal slot 34 and the actuator 90(specifically, its intermediate element 98) may prevent rotation of thecylindrical element 92 of the actuator 90 within the interior 24 of thehousing 20, or at least enable the rotatable element 40 to rotaterelative to the housing 20. During rotation of the rotatable element 40,one or both of the distal retention element 60 and the proximalretention element 70 may rotate relative to the housing 20, whichrotation may also cause the elongate medical instrument 200 to spinrelative to the housing 20 of the rooter 10. If the rooter 10 is heldstationary, or at least substantially stationary, movement of the manualtrigger 100 of the actuator 90 of the rooter 10 may cause the elongatemedical instrument 200 to rotate or spin relative to a subject's body.In other embodiments, the rooter 10 may be used to rotationallyoscillate the elongate medical instrument 200, which may enhance theperformance of the device. Rotation or oscillation of the elongatemedical instrument 200 may be effected during or separately fromlongitudinal movement (e.g., distal movement, proximal movement,back-and-forth movement, etc.) of the elongate medical instrument 200.

When the proximal end 202 of a tubular elongate medical instrument 200(e.g., a catheter, a tube, etc.) is accessible from or proximally beyondthe proximal end of the rooter (e.g., beyond the proximal end 78 of theproximal retention element 70 of the rooter 10, etc.), other activities(e.g., aspiration, infusion, introduction of other elongate medicalinstrument 200, etc.) may be effected through the elongate medicalinstrument 200 while it is assembled with the rooter 10 and, in someembodiments, as the elongate medical instrument 200 is rotated, spun, oroscillated.

In various embodiments, a rooter 10 of the present invention may be usedto enable or effect a variety of medical procedures. Without limitingthe scope of the present invention, medical procedures in which a rootermay be useful include imaging, drug delivery, feeding, stimulation,recording, pacing, temperature sensing, tissue resection, and implantdelivery.

In some embodiments, use of a rooter 10 to manipulate an elongatemedical instrument 200 may facilitate introduction of the elongatemedical instrument 200 into the body of a subject. In other embodiments,an elongate medical instrument 200 may be rotated, spun or oscillatedwith a rooter 10 to facilitate further introduction of the elongatemedical instrument 200 into the body of a subject, or its removal fromthe subject's body.

In still other embodiments, rotation, spinning, or oscillation of anelongate medical instrument 200 may enable the removal of substances(e.g., clots, blockages, etc.) from the body of a subject or fromanother medical device (e.g., a tube, catheter, etc.) within thesubject's body.

In some embodiments, when medical personnel introduce an elongatemedical instrument 200 into the body of a subject through the skin, anatural orifice, a surgical access site, or other natural or man-madestructure, they may encounter friction or obstructions. Some of thecauses of friction or obstructions include, without limitation, tortuouspathways, lesions, viscous fluid (e.g., blood clots, etc.), otherdevices, and combinations of any of the foregoing. Use of a rooter 10 totwist, spin, or oscillate the elongate medical instrument 200 maycounteract any friction that may be encountered as the elongate medicalinstrument 200 is introduced into the body, or during tracking tofacilitate device introduction. As a non-limiting example, a rooter 10may be used to torque a guide wire, which may enable the guide wire todrill through, or cross, lesions or occlusions within a subject'svasculature. In another example, a rooter 10 may rotate a catheter asthe catheter is advanced over a wire into a subject's body, includingsituations where merely pushing the catheter will not cause it toadvance along the wire.

Still another example of use of a rooter 10 includes rotation of aneedle, such as a biopsy needle to facilitate the cutting and removal oftissue or another material from the body of a subject, to access(including intraosseous access, etc.) and/or sample bone marrow, aneedle for use in spinal interventions, or a needle for providinggeneral access to an internal location of a subject's body.

Use of a rooter 10 may also be useful for removing leads, such as thoseused with pacemakers or defibrillators. As leads are removed, rotation,spinning, or oscillation of the leads, or of a sheath that has beenintroduced over the leads, may cut endothelium or fibrin sheaths thatmay hinder removal of the leads from the subject's vasculature.

Although the foregoing description contains many specifics, these shouldnot be construed as limiting the scope of the invention or of any of theappended claims, but merely as providing information pertinent to somespecific embodiments that may fall within the scopes of the inventionand the appended claims. Other embodiments of the invention may also bedevised which lie within the scopes of the invention and the appendedclaims. Features from different embodiments may be employed incombination. The scope of the invention is, therefore, indicated andlimited only by the appended claims and their legal equivalents. Alladditions, deletions and modifications to the invention, as disclosedherein, that fall within the meaning and scopes of the claims are to beembraced thereby.

What is claimed:
 1. A rooter for manually spinning an elongate medicalinstrument with one hand, comprising: a cylindrical housing with alength and an elongated slot extending along the length; a rotatableelement within an interior of the cylindrical housing, the rotatableelement extending through an entirety of the length of the cylindricalhousing, the rotatable element comprising a cylindrical element with arotation facilitator comprising a helical ridge protruding from asurface of the cylindrical element, the helical ridge extending along alength of the interior of the cylindrical housing; a coupling feature onthe rotatable element for rotatably engaging an elongate medicalinstrument; an actuator configured to enable rotation of the rotatableelement with one hand, including: a cylindrical element residing withinthe cylindrical housing, the cylindrical element: surrounding therotatable element; configured to be translated along at least a portionof a length of the rotatable element through a length of the interior ofthe cylindrical housing; including an aperture defining an interiorsurface of the cylindrical element, the interior surface defining adrive feature that complementarily engages the helical ridge of therotation facilitator of the rotatable element and is configured to causethe rotatable element to rotate as the cylindrical element of theactuator is translated along at least a portion of the length of therotatable element; an intermediate portion of the actuator extendingfrom the cylindrical element and through the elongated slot of thecylindrical housing; and an external element: secured to theintermediate portion of the actuator outside of the cylindrical housing;including a trigger protruding from the cylindrical housing; configuredto receive a digit of a hand of an individual; configured to betranslated along the length of the cylindrical housing by the digit; andconfigured to translate the intermediate portion of the actuator alongthe elongated slot in the cylindrical housing and to translate thecylindrical element of the actuator along at least a portion of thelength of the interior of the cylindrical housing; a coiled springwithin the cylindrical housing and surrounding the rotatable element, aproximal end of the coiled spring abutting the cylindrical housing at aproximal end of an interior of the cylindrical housing, a distal end ofthe coiled spring abutting a proximal side of the cylindrical element ofthe actuator to apply a distally oriented biasing force against thecylindrical element of the actuator; and a handle fixedly secured to andprotruding from a proximal location of the cylindrical housing on a sameside of a circumference of the cylindrical housing as the externalelement of the actuator; a conduit extending through a length of therotatable element and communicating with a distal end and a proximal endof the rooter for receiving the elongate medical instrument, wherein therooter is configured to spin the elongate medical instrument during orseparately from longitudinal movement of the elongate medicalinstrument.
 2. The rooter of claim 1, further comprising: a retentionelement at an end of the conduit configured to receive a portion of theelongate medical instrument and configured to engage an outer surface ofthe elongate medical instrument to hold at least the portion of theelongate medical instrument in place within the conduit.
 3. A system forrotating an elongate medical instrument, comprising: an elongate medicalinstrument including a distal end for insertion into the body of asubject and a proximal end; and a rooter configured for manual operationand including: a cylindrical housing with a length and an elongated slotextending along the length; a rotatable element within an interior ofthe cylindrical housing, the rotatable element extending through anentirety of the length of the cylindrical housing, the rotatable elementcomprising a cylindrical element with a rotation facilitator comprisinga helical ridge protruding from a surface of the cylindrical element,the helical ridge extending along a length of the interior of thecylindrical housing; a coupling feature on the rotatable element forrotatably engaging an elongate medical instrument; an actuatorconfigured to enable rotation of the rotatable element with one hand,including: a cylindrical element residing within the cylindricalhousing, the cylindrical element: surrounding the rotatable element;configured to be translated along at least a portion of a length of therotatable element through a length of the interior of the cylindricalhousing; including an aperture defining an interior surface of thecylindrical element, the interior surface defining a drive feature thatcomplementarily engages the helical ridge of the rotation facilitator ofthe rotatable element and is configured to cause the rotatable elementto rotate as the cylindrical element of the actuator is translated alongat least a portion of the length of the rotatable element; anintermediate portion of the actuator extending from the cylindricalelement and through the elongated slot of the cylindrical housing; andan external element: secured to the intermediate portion of the actuatoroutside of the cylindrical housing; including a trigger protruding fromthe cylindrical housing; configured to receive a digit of a hand of anindividual; configured to be translated along the length of thecylindrical housing by the digit; and configured to translate theintermediate portion of the actuator along the elongated slot in thecylindrical housing and to translate the cylindrical element of theactuator along at least a portion of the length of the interior of thecylindrical housing; a coiled spring within the cylindrical housing andsurrounding the rotatable element, a proximal end of the coiled springabutting the cylindrical housing at a proximal end of an interior of thecylindrical housing, a distal end of the coiled spring abutting aproximal side of the cylindrical element of the actuator to apply adistally oriented biasing force against the cylindrical element of theactuator; and a handle fixedly secured to and protruding from a proximallocation of the cylindrical housing on a same side of a circumference ofthe cylindrical housing as the external element of the actuator; aconduit extending through a length of the rotatable element andcommunicating with a distal end and a proximal end of the rooter forreceiving the elongate medical instrument, wherein the rooter isconfigured to rotate the elongate medical instrument during orseparately from longitudinal movement of the elongate medicalinstrument.
 4. The system of claim 3, wherein the elongate medicalinstrument comprises at least one of a needle, a drill bit, a trocar, awire, a catheter, and a tube.
 5. The system of claim 3, wherein therotatable element is configured to enable a proximal end of the elongatemedical instrument to extend proximally beyond the rooter.
 6. The rooterof claim 3, further comprising: a retention element at an end of theconduit configured to receive a portion of the elongate medicalinstrument and configured to engage an outer surface of the elongatemedical instrument to hold at least the portion of the elongate medicalinstrument in place within the conduit.
 7. The system of claim 6,wherein the elongate medical instrument comprises a catheter, a wire, aneedle, a drill bit or a trocar.